GROWING OLD IN CHINA: SYSTEMATIC REVIEW OF LONG-TERM CARE INSURANCE PILOT STUDIES

Abstract Between 1970 and 2020, there was a three-fold increase in China’s ≥65 population, compared to less than a doubling in UK. This rapid-ageing demographic has led to a rise in age-related disabilities. At the same time, internal migration and declining fertility have shaken traditional models of care. An important policy response is to pilot differing long-term care insurance (LTCI) systems, with the aim of establishing equitable care for all. Strengths and limitations of the first set of pilot studies have been identified. In 2020, a second set of 34 pilot studies was introduced. Following PRISMA guidelines, we undertook a systematic review of literature published since introduction of the second pilot phase, to answer the question: ‘what are the key challenges to China achieving an equitable nationwide long-term care system for older people?’. Records were eligible for inclusion if published between June 2020 and June 2022 in Mandarin or English. 42 studies (n=16 Mandarin) were included. Four themes emerged: poor quality of service provision, widespread preference for family care, inequitable distribution of cost burden, and varying LTCI eligibility. Key recommendations included increasing salaries to attract and retain staff, mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart care capacity can support preferences to age at home. Our systematic review highlighted significant challenges in provision of equitable care which suits preferences of its users. China’s LTCI pilots will provide useful lessons for other middle-income countries with rapidly ageing populations.

institutional function: teaching and learning, personnel practices, and student affairs.To begin, experts evaluated the relative importance of 21 common challenges for advancing age inclusivity on U.S. campuses.They then assessed the extent to which 53 potential strategies were appropriate, feasible, and likely to be implemented by campus leaders.In the first round of evaluations, 3 of the 21 challenges were rated as not very important by some experts.On the second round of evaluations, experts assessed why these particular challenges were rated as such.During the first round of reviews, experts also indicated that while 8 strategies were feasible and appropriate to addressing challenges to age inclusivity, they were unlikely to be implemented on campuses.Thus, in the second round, experts were asked why this might have been the case by selecting 2 probable barriers from a list of barriers to adoption.Finally, experts rated the potential impact of all strategies for improving age inclusivity.That is, aside from feasibility or likelihood, the extent to which they thought the strategies could transform age-inclusive environments in higher education.In addition to describing which strategies were most highly recommended, insights will be presented about how the experts viewed various age-friendly challenges and the barriers that hold institutions back from taking up more age-inclusive practices to support older students, faculty, and staff.

PREDICTIONS FOR DEMENTIA BURDEN AND POLICY RESPONSES IN CHINA AND UK BY 2050
Chair: Jing Liao Co-Chair: Eric Brunner The goal of this symposium is to provide a forum to interact with the principal communities, who are developing research on the projection of dementia burden to ageing society and policy responses.It is driven by the UK-China Health and Social Challenges Ageing Project (UKCHASCAP).China's rapid ageing process is occurring at an earlier stage of economic development than many other countries including UK, posing great demands on families, communities and health and care services.Thoughtful comparison of health and social care policy across the contrasting countries will be scientifically illuminating and valuable to policy makers.Preliminary results from four studies will be presented.Two studies based on large ageing cohorts of China and the UK, using multi-state Markov modelling (IMPACT-CAM, IMPACT-BAM) to construct predictions of dementia and related health status (e.g.CVD and physical disability) to 2050.The British model will highlight calculation of dementia incidence trend over time.The following study further used IMPACT-CAM to predict socioeconomic cost of medical, informal and formal care, and quality adjusted life years associated with dementia in China in corresponding years.The fourth study systematically evaluates the effects of implementing long-term care insurance in pilot cities in China, and analyses the main challenges in establishing a nationwide equitable long-term care system for older people.Through this symposium, the panel will provide state-of-art modelling and latest data on the innovative, interdisciplinary and international collaboration for predicting dementia, and provide scientific advices for policy making on healthy ageing in China, the UK and globally.
Abstract citation ID: igad104.0646Yuntao Chen 1 , Piotr Bandosz 2 , George Stoye 3 , Yuyang Liu 4 ,  Sophia Lobanov-Rostovsky 1 , Eric French 5 , Jing Liao 4 ,  and Eric Brunner 1 , 1 Recent evidence suggests dementia incidence rates are declining in high-income countries.However, data for the trend after 2010 are scarce.We examined the temporal trend in England and Wales from 2002-2019, considering bias and non-linearity.We used population-based panel data linked to the mortality register across wave 1 (2002)(2003) to wave 9 (2018-2019) of the English Longitudinal Study of Ageing.Uniform standard criteria based on cognitive and functional impairment were used to ascertain incident dementia cases.Crude incidence rates were determined in seven overlapping initially dementia-free sub-cohorts followed over four years.We estimated the age-and sex-adjusted trend of dementia incidence with Cox and multi-state models.Restricted cubic splines allowed for potential non-linearity.19 806 people were included in the study.Crude dementia incidence declined from 2002 to 2008 (8.7 to 7.4 per 1000 person-years), and increased from 2008 to 2019 (7.4 to 10.3 per 1000 person-years).Adjusting for age and sex, and accounting for missing dementia cases due to death, estimated dementia incidence declined by 28.8% from 2002 to 2008 (incidence rate ratio 0.71, 95% CI 0.58-0.88),and increased by 25.2% from 2008 to 2016 (incidence rate ratio 1.25, 1.03-1.54).The higher education group had a sharper decline of dementia incidence from 2002 to 2008, and a smaller increase after 2008.Dementia incidence may not be declining.There was a rebound after 2008 in England and Wales.If the upward dementia incidence trend continues, along with population ageing, the burden on health and social care may be large.

DOWNWARD DEMENTIA TREND GOES INTO REVERSE IN ENGLAND AND WALES? ENGLISH LONGITUDINAL STUDY OF AGING 2002-2019
Abstract citation ID: igad104.0647

GROWING OLD IN CHINA: SYSTEMATIC REVIEW OF LONG-TERM CARE INSURANCE PILOT STUDIES
Sophia Lobanov-Rostovsky 1 , Qianyu He 2 , Yuntao Chen 1 , Natasha Curry 3 , Eric Brunner 1 , Jing Liao 2 , Nina Hemmings 3 , and Tishya Venkatraman 1 , 1. University College London, London, England, United Kingdom, 2. Sun Yat-Sen University, Guangzhou, Guangdong, China (People's Republic),3. Nuffield Trust,London,England,United Kingdom Between 1970 and 2020, there was a three-fold increase in China's ≥65 population, compared to less than a doubling in UK.This rapid-ageing demographic has led to a rise in age-related disabilities.At the same time, internal migration and declining fertility have shaken traditional models of care.
An important policy response is to pilot differing long-term care insurance (LTCI) systems, with the aim of establishing equitable care for all.Strengths and limitations of the first set of pilot studies have been identified.In 2020, a second set of 34 pilot studies was introduced.Following PRISMA guidelines, we undertook a systematic review of literature published since introduction of the second pilot phase, to answer the question: 'what are the key challenges to China achieving an equitable nationwide long-term care system for older people?'.Records were eligible for inclusion if published between June 2020 and June 2022 in Mandarin or English.42 studies (n=16 Mandarin) were included.Four themes emerged: poor quality of service provision, widespread preference for family care, inequitable distribution of cost burden, and varying LTCI eligibility.Key recommendations included increasing salaries to attract and retain staff, mandatory financial contributions from employees and a unified standard of disability with regular assessment.Strengthening support for family caregivers and improving smart care capacity can support preferences to age at home.Our systematic review highlighted significant challenges in provision of equitable care which suits preferences of its users.China's LTCI pilots will provide useful lessons for other middle-income countries with rapidly ageing populations.

. Division of Prevention Medicine & Education, Medical University of Gdansk, Gdansk, Pomorskie, Poland
Dementia brings a heavy burden on older adults, their family and the society at large.Accurate prediction of dementia prevlance is important for preventive strategy for fast-ageing China.The purpose of this study is to predict dementia prevalence in China by 2050, taking into account variations in dementia incidence rates and mortality rates in future.Based on two nationally representative Chinese ageing cohorts (i.e.CLHLS, CHARLS), a ten-state Markov model (IMPACT-CAM), including prevalence, transition probability and mortality rate of dementia and its associated cardiovaiscualr diseases and disability, was constructed to predict dementia prevalence in people aged above 60 years by 2050, with different assumptions on the furture trends of dementia incidence and mortality rates.IMPACT-CAM projected there were approximately 57.9 million (95% uncententiy interval 56.3-59.6 m) people with dementia by 2050, assuming constant incidence rate of dementia and declining mortality rates over coming years.In comparison with this assumption, if the incidence rate of dementia decreasing by 1.0% annually coupled with declining mortality rates, the projected number of dementia cases would be 9.8 million less; if dementia incidence and mortality rates both remained constant since 2022, the projection would be 18.5 million less.The estimated dementia prevlance for people aged 60 years in 2050 were 12.0%, 9.9% and 9.5%, respectively.Alongside the irreversible population ageing trend, the number of people with dementia in China is likely to increase rapidly in the near furture.Nevertheless, effective preventing measures of dementia would restrain the surge substantially.This study projected the socioeconomic cost and quality adjusted life years (QALYs) lost to dementia in China from 2020 to 2050, and tested robustness of these projections.Using a multi-state Markov model, we projected the number of dementia cases and other health states in China to 2050.Corresponding socioeconomic costs (healthcare, formal care and informal care costs) and QALYs of these health states were forecasted based on China Health and Retirement Longitudinal Study (N=25029) and Chinese Longitudinal Healthy Longevity Survey (N=32628).A series of sensitivity analyses were conducted to test robustness of projections depending on different assumptions.We showed that nearly 2.7% of the age 50+ population had dementia in China in 2020, and the share of total socioeconomic cost per year was 12.2% for those with dementia.Socioeconomic cost and cost of QALYs lost to dementia in 2050 would reach 1189.0 and 807.4 billion US$ respectively.The dominant contributor to socioeconomic costs was informal care costs, while formal care costs covered the smallest share.Furthermore, sensitivity analyses showed that changes to formal care usage would lead to more robust changes in socioeconomic cost of dementia than the unit price of social care.Projected cost would decrease by 13.9% or increase by 34.5% in 2050, depending on different assumptions of time trend of dementia incidence.The socioeconomic cost and cost of QALYs lost to dementia in China are expected to continue their rapid growth into future, with informal care costs being the most significant contributor.

MOBILIZING INTERDISCIPLINARY RESEARCH TO ILLUMINATE DIVERSITY ACROSS THE CANCER CARE CONTINUUM
Chair: Sean Halpin Co-Chair: Jessica Krok-Schoen Cancer diagnoses increase precipitously with age, impacting diverse populations who have different experiences, needs, and resources.In our symposium, we bring together researchers from multiple disciplines to present on the diversity of older adults living with cancer and the ways that health care providers, systems, and researchers are innovating to support them.Carrion presents the knowledge